Narcan Set To Become Available Over-The-Counter—Which Means Insurance May Not Cover It

Topline

Over-the-counter Narcan and other naloxone nasal sprays are expected to hit pharmacies and online drug stores as early as next month, and although some insurance companies may not continue covering the cost of the drugs, pharmacies and insurance providers are finding a workaround to offer at least partial coverage.

Key Facts

The Food and Drug Administration approved Narcan (brand name for naloxone) for over-the-counter use in March, RiVive—another naloxone nasal spray—in July and approved drugmaker Padagis’ generic version of the drugs in July for over-the-counter use as well.

Narcan and other naloxone nasal sprays work by rapidly reversing an opioid overdose by attaching to opioid receptors and blocking the drug’s effects.

A box of Narcan containing two doses will have a suggested retail price of $44.99, according to a statement Wednesday from the manufacturer, Emergent BioSolutions.

While insurance companies paid for naloxone when it was by prescription only, insurance does not usually cover over-the-counter drugs, though some state insurers have announced plans to continue coverage of Narcan, including Blue Cross Blue Shield of Massachusetts, MassHealth, Massachusetts’ Medicaid program and other Medicaid and Medicare in states like California, Rhode Island, Missouri, Washington and Oregon.

Narcan is expected to be available at drug stores, pharmacies, grocery stores and online retailers, like CVS, Walgreens and Walmart, in-store and online in September.

Each dose of naloxone from RiVive will sell for $18, nearly $5 cheaper than Narcan, but its manufacturer, Harm Reduction Therapeutics (HRT), will focus distribution to harm-reduction organizations and state governments before arriving at drug stores.

RiVive is expected to be available by early 2024, and HRT — which plans to make two million doses per year — will give away 10% of the product for free, the company said.

The generic option, made by Padagis, does not yet have a price or date of expected availability.

Although there is no federal age limit for buying Narcan, pharmacists might refuse giving it to someone under the age of 16 due to state age restrictions, according to the Substance Abuse and Mental Health Services Administration.

Contra

Narcan was covered by public and private insurance when it was only available by prescription, but now that it’s over-the-counter, customers in some states may have to fully pay out of pocket because over-the-counter medications aren’t usually covered by insurance plans. Health groups have raised concern about patients’ inability to afford Narcan without insurance coverage. The National Health Law Program urged states to enact laws requiring private insurance companies to continue over-the-counter coverage of the drug and to put a standing order in place for Medicaid state plans to ensure Narcan has over-the-counter coverage. Bobby Mukkamala, chair of the American Medical Association’s Substance Use and Pain Care Task Force, said the retail price of Narcan is “something that’s going to be prohibitive for a lot of people,” and urged manufacturers to make the price more “affordable.” The Network for Public Health Law (NPHL) warned that because some states don’t require coverage of Narcan, “those who need it most may still not be able to afford it.” The NPHL called on Congress and state governments to require insurance coverage for over-the-counter Narcan and other naloxone products.

Big Number

109,680. That’s how many people died as a result of a drug overdose in 2022, according to data from the Centers for Disease Control and Prevention, the most overdose-related deaths the U.S. has seen. Both Wyoming and Washington state saw the largest increases, with each seeing a 21% jump in deaths.

Crucial Quote

“Approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country,” FDA commissioner Robert M. Califf said. “We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.”

Key Background

Narcan is specifically used for overdoses in opioids like fentanyl, oxycodone and heroin. Because it doesn’t cause any known health effects to someone who is not overdosing from opioids, the California Department of Public Health recommends giving Narcan to anyone suspected of any type of overdose. There are injectable versions of naloxone that still require prescription, which typically requires the proper dosage to be drawn up from a vial. Narcan and other nasal spray versions are reportedly easier for regular people who aren’t medical professionals to use because they don’t necessarily require training. Signs of opioid overdose include an extremely pale or clammy face, a limp body, slowed or stopped breathing or heart rate, blue or purple fingernails or lips, vomiting or gurgling noises and inability to speak. Both Narcan and Padagis’ generic version will be available in four milligram doses and RiVive will come in three milligram doses. Though RiVive is a lower dose, it’s still effective at reversing opioid overdoses.